Alternatives for back pain

Back pain. Eighty percent of us have it at some point, and it's notoriously hard to treat because the source of the pain can involve the muscles, ligaments, joints or tendons.

Yoga, acupuncture, massage, herbs and spinal manipulation can be effective, especially when used as part of a comprehensive treatment plan, experts say.

"Everything works better when it is part of a whole-person care approach, which includes good nutrition, appropriate exercise, good sleep and stress management," said Dr. Brent Bauer, director of Mayo Clinic's Complementary and Integrative Medicine Program.

Here's a quick look at the evidence behind some commonly used options:

Yoga: Studies suggest yoga can help diminish back pain because the physical poses involve movement and incorporate both stretching and strengthening of the muscles. Any long-term improvement in back pain "comes from patients' having realistic expectations, managing their own pain and exercising regularly," said Simon Dagenais, co-author of the textbook "Evidence-Based Management of Low Back Pain." In the largest study to date on yoga and back pain, researchers found that attending 12 weeks of yoga classes was an effective and safe option for those with moderate low back pain. The study, published in the Annals of Internal Medicine, found that participants were able to use less medication to manage their lower back pain. Not a yoga fan? The researchers found stretching also provided benefits.

Acupuncture: When added to other conventional therapies, acupuncture relieves pain and improves function better than using conventional therapies alone, according to a review of studies called a Cochrane Summary. Unfortunately, "many trials show that real acupuncture is not better than sham acupuncture," said Dr. Andrea Furlan, an associate scientist at the Institute for Work & Health and a member of the Cochrane Back Review Group. Still, she believes it may be worth trying for a limited time, about 10 sessions.

Massage: It can help with both short-term and chronic back pain, especially in conjunction with exercise. Massage "relaxes the muscles, and it causes the body to release pain-relieving substances (like our endogenous endorphins) and also relaxes the mind," said Furlan. Swedish massage and acupressure have been shown to be the most effective forms.

Chiropractic or spinal manipulation: Overall, studies show that spinal manipulation can provide mild to moderate relief of low back pain, according to the National Center for Complimentary and Alternative Medicine. It appears to work at least as well as taking pain relievers, a firmer mattress or applying heat. A 2010 report by the federal Agency for Healthcare Research and Quality found that spinal manipulation was more effective than placebo. But the researchers noted inconsistent results when they compared it with massage or physical therapy as a way to reduce low-back pain intensity.

Prolotherapy: This involves injecting a substance — commonly a sugar solution — into the body. In theory, this triggers an acute inflammatory response so the body's natural healing system can kick in. Though it's gaining popularity, there's little research and not enough evidence to warrant recommending it yet. "Most of the studies that have found positive effects have been in joints like the knee," said Bauer. "Studies in patients with low back pain have been more mixed."

Herbs: There's mixed evidence on using herbs for back pain. Devil's claw has some supportive data, said Bauer, but there's no evidence the herbs that have been studied are safe or useful long term. "Glucosamine, chondroitin, SAMe all might have some benefit as an adjunct to an overall conventional treatment program," said Bauer.